Stronger than Ever: Multifilament Fiberglass Posts Boost Maxillary Premolar Fracture Resistance.

This paper investigates the influence of cavity configuration and post-endodontic restoration on the fracture resistance, failure mode and stress distribution of premolars by using a method of fracture failure test and finite elements analysis (FEA) coupled to Weibull analysis (WA). One hundred premolars were divided into one control group (Gcontr) (n = 10) and three experimental groups, according to the post-endodontic restoration (n = 30), G1, restored using composite, G2, restored using single fiber post and G3, restored using multifilament fiberglass posts (m-FGP) without post-space preparation. Each experimental group was divided into three subgroups according to the type of coronal cavity configuration (n = 10): G1O, G2O, and G3O with occlusal (O) cavity configuration; G1MO, G2MO, and G3MO with mesio-occlusal (MO); and G1MOD, G2MOD, and G3MOD with mesio-occluso-distal (MOD). After thermomechanical aging, all the specimens were tested under compression load, and failure mode was determined. FEA and WA supplemented destructive tests. Data were statistically analyzed. Irrespective of residual tooth substance, G1 and G2 exhibited lower fracture resistance than Gcontr (p < 0.05), whereas G3 showed no difference compared to Gcontr (p > 0.05). Regarding the type of restoration, no difference was highlighted between G1O and G2O, G1MO and G2MO, or G1MOD and G2MOD (p > 0.05), whereas G3O, G3MO, and G3MOD exhibit higher fracture resistance (p < 0.05) than G1O and G2O, G1MO and G2MO, and G1MOD and G2MOD, respectively. Regarding cavity configuration: in G1 and G2, G1O and G2O exhibited higher fracture resistance than G1MOD and G2MOD, respectively (p < 0.05). In G3, there was no difference among G3O, G3MO and G3MOD (p > 0.05). No difference was found among the different groups and subgroups regarding the failure mode. After aging, premolars restored with multifilament fiberglass posts demonstrated fracture resistance values comparable to those of an intact tooth, irrespective of the different type of cavity configuration.

Do the Mechanical Properties of Calcium-Silicate-Based Cements Influence the Stress Distribution of Different Retrograde Cavity Preparations?

The aim of the present study was to investigate the influence of the mechanical properties of three different calcium-silicate-based cements on the stress distribution of three different retrograde cavity preparations. Biodentine™ "BD", MTA Biorep "BR", and Well-Root™ PT "WR" were used. The compression strengths of ten cylindrical samples of each material were tested. The porosity of each cement was investigated by using micro-computed X-ray tomography. Finite element analysis (FEA) was used to simulate three retrograde conical cavity preparations with an apical diameter of 1 mm (Tip I), 1.4 mm (Tip II), and 1.8 mm (Tip III) after an apical 3 mm resection. BR demonstrated the lowest compression strength values (17.6 ± 5.5 MPa) and porosity percentages (0.57 ± 0.14%) compared to BD (80 ± 17 MPa-1.22 ± 0.31%) and WR (90 ± 22 MPa-1.93 ± 0.12%) (p < 0.05). FEA demonstrated that the larger cavity preparation demonstrated higher stress distribution in the root whereas stiffer cement demonstrated lower stress in the root but higher stress in the material. We can conclude that a respected root end preparation associated with cement with good stiffness could offer optimal endodontic microsurgery. Further studies are needed to define the adapted cavity diameter and cement stiffness in order to have optimal mechanical resistance with less stress distribution in the root.

Experimental study of risk of medial hinge fracture during distal femoral varus osteotomy.

INTRODUCTION: Lateral opening wedge distal femoral osteotomy (LOWDFO) is indicated for isolated lateral osteoarthritis in the valgus morphotype. Medial hinge fracture is a factor for poor prognosis. The present study had two aims: (1) to assess the impact of a temporary K-wire on hinge fracture risk; and (2) to assess the impact of LOWDFO opening speed. HYPOTHESIS: The main study hypothesis was that a temporary hinge K-wire reduces hinge fracture risk. The second hypothesis was that faster opening speed increases fracture risk. MATERIAL AND METHOD: Twenty femurs were produced by 3D printing from a CT database, reproducing LOWDFO anatomy. The ABS® polymer showed the same breaking-point behavior as human bone. Ten specimens were included in the "K-wire" group (KW+) and 10 in the "No K-wire" group (KW-). To determine high and low speed, a motion-capture glove was used by 2 operators, providing 3D modeling of the surgeon's hand. High speed was defined as 152mm/min and low speed as 38mm/min. The KW+ and KW- groups were subdivided into high- and low-speed subgroups (HS, LS) of 5 each. Compression tests were conducted using an Instron® mechanical test machine up to hinge fracture. The main endpoint was maximum breaking-point force (N); the secondary endpoints were maximum displacement (mm) and maximum speed (min) at breaking point. RESULTS: The K-wire significantly increased maximum breaking-point force (LS, 143.08N vs. 93.71N, p<0.01; and HS, 186.98N vs. 95.22N, p<0.01), but not maximum displacement (LS, 26.17mm vs. 24.11mm, p=0.31; and HS 26.18mm vs. 23.66mm, p=0.14) or maximum time (LS, 27.07s vs. 24.94s, p=0.31; and HS, 5.24s vs. 4.73s, p=0.14). Speed did not affect maximum force (KW+, 143.08N vs. 186.98N, p=0.06; and KW-, 93.71N vs. 95.22N, p=0.42) or maximum displacement (KW+, 26.17mm vs. 26.18mm, p=1; and KW-, 24.11mm vs. 23.66mm, p=0.69). Only maximum time was greater at low speed (KW+, 27.07s vs. 5.24s, p>0.01; and KW-, 24.94s vs. 4.73s, p<0.01), which is obvious for constant distance. DISCUSSION: The first study hypothesis was confirmed, with significantly lower hinge fracture risk with the K-wire, independently of opening speed. The second hypothesis was not confirmed. The study was performed under strict experimental conditions, unprecedented to our knowledge in the literature. However, complementary clinical studies are needed to confirm the present findings. LEVEL OF EVIDENCE: IV, experimental study.

Compressive Strength and Porosity Evaluation of Innovative Bidirectional Spiral Winding Fiber Reinforced Composites.

The aim of this in vitro study was to investigate the compressive strength and the bulk porosity of a bidirectional (bFRC) and an experimental bidirectional spiral winding reinforced fiber composite (bswFRC). Cylindrical-shape specimens were prepared for each material group and processed for the evaluation of compressive strength after different storage conditions (dry, 1 and 3 months) in distilled water at 37 °C. The specimens were also assessed for the degree of bulk porosity through X-ray tomography. A scanning electron microscope (SEM) was used to determine the fracture mode after a compressive strength test. Data were statistically analyzed using Two-Way Analysis of Variance (ANOVA). A significantly lower compressive strength was obtained in dry conditions, and after 1 month of water immersion, with the specimens created with bFRC compared to those made with bswFRC (p < 0.05). No significant difference (p > 0.05) was found between the two groups after 3 months of water immersion. However, the presence of water jeopardized significantly the compressive strength of bswFRC after water storage. The type of fracture was clearly different between the two groups; bswFRC showed a brutal fracture, whilst bFRC demonstrated a shear fracture. The bswFRC demonstrated higher pore volume density than bFRC. In conclusion, bswFRC is characterized by greater compressive strength compared to bFRC in dry conditions, but water-aging can significantly decrease the mechanical properties of such an innovative FRC. Therefore, both the novel bidirectional spiral winding reinforced fiber composites (bswFRC) and the bidirectional fiber reinforced composites (bFRC) might represent suitable materials for the production of post-and-core systems via CAD/CAM technology. These findings suggest that both FRC materials have the potential to strengthen the endodontically treated teeth.

Experimental investigation of the risk of lateral cortex fracture during valgus tibial osteotomy.

BACKGROUND: Valgus-producing medial opening-wedge proximal tibial osteotomies (V-MOW-PTO) are used to treat isolated medial-compartment knee osteoarthritis in patients with varus malalignment. A fracture of the lateral cortical hinge is a risk factor for poor outcomes. Implantation of a protective K-wire has been suggested to prevent this complication. The primary objective of this bench study was to assess the ability of a protective K-wire to prevent lateral cortical fractures. The secondary objective was to evaluate the influence of the opening speed on fracture risk during the osteotomy. HYPOTHESIS: The primary hypothesis was that a protective K-wire decreased the risk of hinge fracture. The secondary hypothesis was that this risk was greater when the opening speed was high. MATERIALS AND METHODS: We performed an experimental study of 20 simulated thermoplastic-polymer (ABS) tibias obtained by 3D printing to assess the effects of wedge-opening speed (high vs. low) and presence of a protective K-wire (yes vs. no). The opening rates were determined in a preliminary study of Sawbone® specimens opened using a distractor. The opening rate was measured using an accelerometer via a motion-capture glove. After assessing several high and low opening speeds, we selected 38mm/min and 152mm/min for the study. We divided the 20 ABS specimens into four groups of five each: high speed and K-wire, low speed and K-wire, high speed and no K-wire, and low speed and no K-wire. The force was applied using an Instron™ testing machine until construct failure. The primary outcome measure was the load at failure (N) and the secondary outcome measures were the displacement (mm) and maximum time to failure (s). RESULTS: At both speeds, values were significantly higher with vs. without a K-wire for load to failure (low: 253.3N vs. 175.5N, p<0.01; high: 262.2N vs. 154.1N, p<0.01), displacement (low: 11.1mm vs. 8.7mm, p<0.01; high: 11mm vs. 8.9mm; p=0.012), and maximal time to failure (low: 11.4 s vs. 8.9 s; p=0.012; high: 2.2 s vs. 1.8 s; p=0.011). Thus, the osteotomy opening speed seemed to have no influence on the risk of lateral cortex fracture. DISCUSSION: Our main hypothesis was confirmed but our secondary hypothesis was refuted: a protective K-wire significantly decreased the risk of hinge fracture, whereas the osteotomy opening speed had no influence. To our knowledge, this is the first published study assessing the potential influence of opening speed on risk of lateral cortex fracture. Our findings were obtained in the laboratory and should be evaluated in clinical practice. LEVEL OF EVIDENCE: IV, experimental study.

Torsional, Static, and Dynamic Cyclic Fatigue Resistance of Reciprocating and Continuous Rotating Nickel-Titanium Instruments.

INTRODUCTION: The aim of this study was to evaluate torsional, dynamic, and static cyclic fatigue resistance of the reciprocating One RECI (OR; Micromega, Besançon, France), WaveOne Gold (WOG; Dentsply Maillefer, Ballaigues, Switzerland), rotary One Curve (OC, MicroMega), and ProTaper Next X2 (PTN X2; Dentsply Sirona, Charlotte, NC) instruments. METHODS: A total of 120 OR (n = 30), WOG (n = 30), OC (n = 30), and PTN X2 (n = 30) nickel-titanium instruments were used. Torque and rotation angle until failure under static torsion loading were measured according to ISO 3630-1. Static and dynamic fatigue resistance was measured as the time to fracture in an artificial stainless steel canal with a 60° angle and 5-mm radius of curvature at intracanal temperature. The results were analyzed with 1-way analysis of variance and the post hoc Tukey test. The alpha-type error was set at 5%. Fracture instruments from torsion and fatigue tests were examined with a scanning electron microscope. RESULTS: OR showed higher static fatigue resistance and rotation angle at fracture than WOG, OC, and PTN X2 (P < .05). WOG exhibited higher torsional resistance than the others (P < .05). The cyclic fatigue tests in dynamic mode had higher TTF than static for the PTN X2 and WOG groups (P < .05). In the dynamic tests, OR and WOG showed higher TTF than OC and PTN X2 (P < .05). CONCLUSIONS: Under these experimental conditions, One RECI exhibited suitable mechanical properties with the highest cyclic fatigue resistance and angle of rotation among the tested instruments.

Physicochemical and Mechanical Properties of Premixed Calcium Silicate and Resin Sealers.

The aim of the present in vitro study was to evaluate specific mechanical and physicochemical properties of two calcium silicate based sealers, (AH Plus Bioceramic "AHPB"; Well-Root ST "WRST"), and a conventional resin sealer (AH Plus "AHP"). These aims were accomplished by assessing the porosity, pH, compression strength, roughness, wettability and cell attachment of the tested materials. The results were compared statistically using the one-way ANOVA test. Higher pH values were obtained in both AHPB and WRST compared to AHP at 3, 24 and 72 h (p < 0.05). A greater level of porosity and wettability was detected for both AHPB and WRST compared to the resin sealer AHP (p < 0.05). Evident cell growth characterized by elongated morphology was observed on the surface of AHPB and WRST, while only a thin layer of cells was seen on the surface of AHP. A significant lower compression strength and modulus were obtained in the specimens created using AHPB compared to those made with AHP and WRST (p < 0.05). The removal of calcium silicates may be quite tricky during endodontic retreatment. In conclusion, considering the limitations of the present in vitro study, both calcium silicate sealers demonstrated good physicochemical properties. However, the lower compression strength and modulus of AHPB may facilitate its removal and make the retreatment procedures considerably easier.

Does Multi-Fiber-Reinforced Composite-Post Influence the Filling Ability and the Bond Strength in Root Canal?

The purpose of the present in vitro study was to investigate the bond strength of root canal dentin and the filling ability of a new multi-fiber-reinforced composite post (mFRC) compared to a conventional single fiber-reinforced-composite post (sFRC). Twenty-eight freshly maxillary first permanent single-rooted premolars were instrumented and divided into groups (n = 14). Group 1: single-fiber-reinforced composite (sFRC), group 2: multi-fiber-reinforced composite (mFRC). Bonding procedures were performed using a dual-cure universal adhesive system and resin cement. All specimens were sectioned so that seven discs of 1 mm of thickness were obtained from each root. An optical microscope was used before the push-out test to measure the total area of the voids and to determine the length of the smaller/bigger circumferences. The push-out bond strength (PBS) test was performed using an Instron universal testing machine. Data were then compared by one-way ANOVA on ranks (α = 0.05). The dentin-cement-post interface was observed using scanning electron microscopy (SEM). At the coronal third, a significantly higher bond strength (p < 0.05) was obtained in the sFRC group (44.7 ± 13.1 MPa) compared to the mFRC group (37.2 ± 9.2 MPa). No significant difference was detected between the groups at the middle third (sFRC group "33.7 ± 12.5 MPa" and mFRC group "32.6 ± 12.4 MPa") (p > 0.05). Voids were significantly lower in the mFRC compared to those observed in the sFRC group (p < 0.05) at the coronal third. Whereas, no significant difference was found at the middle third (p > 0.05) between the tested groups. Filling ability was overall improved when employing mFRC, although such technique might have characteristic limitations concerning the bond strength to dentin.

Dual role of tannic acid and pyrogallol incorporated in plaster of Paris: Morphology modification and release for antimicrobial properties.

The design of bioactive plasters is of major interest for the amelioration of dental and bone cements. In this article, a one pot and environmentally friendly strategy based on the addition of a cheap polyphenol-tannic acid (TA) or the main phenolic constituent of TA, namely pyrogallol (PY)- able to interact with calcium sulfate is proposed. Tannic acid and pyrogallol not only modify the morphology of the obtained plaster+TA/PY composites but a part of it is released and provides strong-up to twenty fold- antibacterial effect against Staphylococcus aureus. It is shown that the higher antibacterial efficiency of PY is related to a greater release compared to TA even if in solution the antibacterial effect of PY is lower than that of TA when reported on the basis of the molar concentration in PY units.

Antibacterial and Bonding Properties of Universal Adhesive Dental Polymers Doped with Pyrogallol.

This study investigated the antibacterial activity, bond strength to dentin (SBS), and ultra-morphology of the polymer-dentin interface of experimental adhesive systems doped with pyrogallol (PY), which is a ubiquitous phenolic moiety that is present in flavonoids and polyphenols. A universal adhesive containing 4-META and 10-MDP was used in this study. PY behaves as an antioxidant and anti-cancerogenic agent and it was incorporated into the adhesive at different concentrations (0.5 and 1 wt.%). The antibacterial activity and SBS were analyzed and the results were statistically analyzed. The ultra-morphology of the polymer-dentin interface was assessed using scanning electron microscopy (SEM). At 24 h, a lower antibacterial activity was observed for the control adhesive compared to those with 0.5% and 1% PY. No difference was seen in SBS between the three groups at 24 h. After 6 months, the SBS of the 0.5% PY adhesive was significantly lower than the other tested adhesives. The specimens created with 1% PY adhesive presented a higher bond strength at six months compared with that found at 24 h. No morphological differences were found at the polymer-dentin interfaces of the tested adhesives. Pyrogallol may be incorporated into modern universal adhesive systems to preserve the polymer-dentin bonding interface and confer a certain degree of antibacterial activity.

Tannic acid speeds up the setting of mineral trioxide aggregate cements and improves its surface and bulk properties.

HYPOTHESIS: The setting time and mechanical properties of cements are a major technical concern for a long time in civil engineering. More recently those practical problems became a major concern for biomedical applications -in bone surgery and in dentistry- in particular concerning the setting time which should be minimized. The possibility to add organic additives to interact with the different constituting ions in cements constitutes a way to modify the setting kinetics. We made the assumption that a hydrolysable polyphenol like tannic acid could modify the setting time and the physical properties of Mineral Trioxide Aggregate (MTA). EXPERIMENTS: Tannic acid is added in variable proportions to the water used to set MTA. The formation of the hybrid organic-mineral cements is investigated using a combination of structural, chemical and mechanical methods. X-ray tomography was also used to investigate the changes in porosity and pore size distribution upon incorporation of tannic acid in MTA based cements. The hydrophilicity of the cements was evaluated by measuring the permeation kinetics of small water droplets. FINDINGS: We found that tannic acid allowed to reduce markedly the setting time of MTA based cements. The obtained cements have an increased hydrophilicity and display excellent resistance to compression. The number of pores but not the average pore size is also affected. The possible roles of tannic acid in modifying the cement properties are discussed.

Influence of the grade on the variability of the mechanical properties of polypropylene waste.

The prior properties of recycled polypropylene depend on the origin of waste deposits and its chemical constituents. To obtain specific properties with a predefine melt flow index of polypropylene, the suppliers of polymer introduce additives and fillers. However, the addition of additives and/or fillers can modify strongly the mechanical behaviour of recycled polypropylene. To understand the impact of the additives and fillers on the quasi-static mechanical behaviour, we consider, in this study, three different recycled polypropylenes with three different melt flow index obtained from different waste deposits. The chemical constituents of the additives and filler contents of the recycled polypropylenes are determined through thermo-physico-chemical analysis. Tensile and bending tests performed at different strain rates allow identifying the mechanical properties such as the elastic modulus, the yield stress, the maximum stress, and the failure mechanisms. The results obtained are compared with non-recycled polypropylene and with few researches to explain the combined effect of additives. Finally, a post-mortem analysis of the samples was carried out to make the link between the obtained mechanical properties and microstructure.